Amsterdam J D, Maislin G, Droba M, Winokur A
Psychiatry Res. 1987 Apr;20(4):325-36. doi: 10.1016/0165-1781(87)90094-1.
Excessive cortisol secretion after cosyntropin (adrenocorticotropic hormone; ACTH) infusion in some depressed patients has suggested the possibility that the adrenal cortex may have heightened responsiveness to ACTH, and that this may contribute, in part, to activation of the hypothalamic-pituitary-adrenocortical axis. We administered an ACTH test and dexamethasone suppression test (DST) to 32 patients before and after treatment. Maximal cortisol response to ACTH demonstrated a significant decrease after treatment in the subgroup of melancholic/DST nonsuppressors (p = 0.04). When the cumulative cortisol response (CCR) to ACTH was examined, the DST nonsuppressors had a greater CCR decrease than suppressors (p = 0.03), and the melancholics a greater decrease than nonmelancholics (p = 0.02). The melancholic/DST nonsuppressor subgroup had the largest CCR decrease after treatment (p = 0.03), and these patients may represent a group of depressives with altered adrenocortical function that tends to "normalize" with clinical recovery.
在一些抑郁症患者中，静脉注射促肾上腺皮质激素（ACTH）后皮质醇分泌过多，这表明肾上腺皮质对ACTH的反应性可能增强，并且这可能在一定程度上导致下丘脑-垂体-肾上腺皮质轴的激活。我们在治疗前后对32例患者进行了ACTH试验和地塞米松抑制试验（DST）。在忧郁症/DST非抑制者亚组中，治疗后皮质醇对ACTH的最大反应显著降低（p = 0.04）。当检查皮质醇对ACTH的累积反应（CCR）时，DST非抑制者的CCR降低幅度大于抑制者（p = 0.03），忧郁症患者的降低幅度大于非忧郁症患者（p = 0.02）。忧郁症/DST非抑制者亚组治疗后的CCR降低幅度最大（p = 0.03），这些患者可能代表了一组肾上腺皮质功能改变的抑郁症患者，其肾上腺皮质功能倾向于随着临床康复而“恢复正常”。
